NU 155 Final Exam Medical Surgical
Nursing I Galen College ACTUAL
EXAM 2026/2027 | Galen NU 155 Med
Surg I Final | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: FLUID & ELECTROLYTES (Questions 1–15)
Q1. A client with heart failure has a serum potassium of 2.9 mEq/L and is prescribed furosemide 40 mg
IV. Which action should the nurse take first?
A. Administer furosemide as ordered
B. Check the client's last serum magnesium level
C. Hold the furosemide and notify the provider
D. Apply cardiac monitoring leads
Correct Answer: C
Rationale: Furosemide is a loop diuretic that exacerbates potassium loss. With a serum potassium of 2.9
mEq/L (severe hypokalemia), administering furosemide increases the risk of fatal dysrhythmias. The
nurse must hold the medication and notify the provider for potassium replacement before diuresis. This
follows the priority framework of treating life-threatening electrolyte imbalances before completing
other actions.
Q2. A client is admitted with diabetic ketoacidosis. Arterial blood gas results show: pH 7.28, PaCO₂ 28
mmHg, HCO₃⁻ 14 mEq/L, PaO₂ 92 mmHg. Which interpretation is correct?
A. Respiratory acidosis with partial compensation
B. Metabolic acidosis with full compensation
,C. Metabolic acidosis with partial compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: C
Rationale: The pH of 7.28 indicates acidemia. The low HCO₃⁻ (14 mEq/L) is the primary disorder,
indicating metabolic acidosis. The PaCO₂ is decreased to 28 mmHg, showing the lungs are attempting to
compensate by hyperventilating, but the pH remains abnormal, indicating only partial compensation.
Full compensation would return the pH to the normal range (7.35–7.45).
Q3. A postoperative client has the following lab values: Na⁺ 132 mEq/L, K⁺ 3.2 mEq/L, Cl⁻ 98 mEq/L, Ca²⁺
8.4 mg/dL. The client reports numbness around the mouth and muscle cramps. Which intervention is
the priority?
A. Administer 0.9% NaCl at 125 mL/hr
B. Administer oral potassium chloride 40 mEq
C. Administer IV calcium gluconate per protocol
D. Increase oral fluid intake to 3 L/day
Correct Answer: C
Rationale: The client exhibits signs of hypocalcemia (numbness around mouth, muscle cramps) with a
serum calcium of 8.4 mg/dL (normal 8.5–10.5 mg/dL). Hypocalcemia can lead to tetany, laryngospasm,
and seizures. IV calcium gluconate is the priority intervention to prevent life-threatening complications.
The ABC framework and safety priority guide the nurse to address the most immediately dangerous
electrolyte imbalance first.
Q4. A client receiving total parenteral nutrition (TPN) at 75 mL/hr develops chills, temperature 38.9°C
(102°F), and blood pressure 88/52 mmHg. Which action should the nurse take first?
A. Draw blood cultures from two separate sites
B. Discontinue the TPN infusion and change the tubing
C. Administer acetaminophen 650 mg PO
D. Increase the IV fluid rate to 150 mL/hr
Correct Answer: B
Rationale: The client exhibits classic signs of catheter-related bloodstream infection (CRBSI) or sepsis
from contaminated TPN. The first priority is to remove the source of infection by discontinuing the TPN
and changing the tubing. This follows the principle of eliminating the causative agent before supportive
interventions, aligning with infection control priorities and sepsis bundle protocols.
,Q5. [SELECT ALL THAT APPLY] A client with syndrome of inappropriate antidiuretic hormone (SIADH) has
the following findings. Which findings are consistent with this diagnosis? (Select all that apply.)
A. Serum sodium 118 mEq/L
B. Urine specific gravity 1.030
C. Serum osmolality 240 mOsm/kg
D. Blood pressure 168/96 mmHg
E. Urine output 3,500 mL in 24 hours
F. Decreased deep tendon reflexes
Correct Answers: A, B, C, F
Rationale: SIADH is characterized by water retention and dilutional hyponatremia. Serum sodium below
135 mEq/L (A) is the hallmark finding. Urine specific gravity is elevated (B) because ADH promotes water
reabsorption in the collecting ducts, concentrating the urine. Serum osmolality is low (C) due to dilution.
Decreased deep tendon reflexes (F) occur with severe hyponatremia as water shifts into cells causing
cerebral edema. Blood pressure is typically normal or slightly elevated, not severely hypertensive (D).
Urine output is decreased, not increased (E), because of water retention.
Q6. [ORDERED RESPONSE – PRIORITY] A nurse is caring for a client with hypovolemic shock secondary
to severe diarrhea. Place the following interventions in order of priority.
1. Insert a large-bore IV catheter and begin fluid resuscitation
2. Apply supplemental oxygen at 15 L/min via non-rebreather mask
3. Obtain a complete set of vital signs
4. Place the client in Trendelenburg position
Correct Answer: 2, 3, 4, 1
Rationale: The ABC priority framework guides this sequence. First, apply supplemental oxygen (2) to
address potential hypoxia and support tissue perfusion. Next, obtain vital signs (3) to establish a
baseline and guide intervention intensity. Then, place the client in Trendelenburg position (4) to
improve venous return to the heart and cerebral perfusion. Finally, insert a large-bore IV and begin fluid
resuscitation (1) to restore intravascular volume. Oxygenation takes precedence over circulation in the
initial stabilization phase.
Q7. [HOT SPOT – LAB VALUE INTERPRETATION] A client's laboratory report shows the following values.
Identify which values are ABNORMAL and require nursing intervention.
Table
, Lab Value Result Normal Range
Serum Na⁺ 148 mEq/L 135–145 mEq/L
Serum K⁺ 4.2 mEq/L 3.5–5.0 mEq/L
Serum Cl⁻ 102 mEq/L 98–106 mEq/L
Serum Mg²⁺ 1.4 mg/dL 1.7–2.2 mg/dL
Serum Phos 4.8 mg/dL 2.5–4.5 mg/dL
BUN 32 mg/dL 7–20 mg/dL
Creatinine 1.1 mg/dL 0.6–1.2 mg/dL
Correct Answer: Abnormal values requiring intervention: Na⁺ 148 mEq/L (hypernatremia), Mg²⁺ 1.4
mg/dL (hypomagnesemia), Phos 4.8 mg/dL (hyperphosphatemia), BUN 32 mg/dL (elevated).
Rationale: Hypernatremia (148 mEq/L) indicates dehydration or excess sodium intake and requires fluid
management. Hypomagnesemia (1.4 mg/dL) increases risk of dysrhythmias and often accompanies
hypokalemia and hypocalcemia; magnesium replacement is needed before other electrolytes will
correct. Hyperphosphatemia (4.8 mg/dL) suggests renal impairment or tissue breakdown. Elevated BUN
(32 mg/dL) with normal creatinine suggests prerenal azotemia from dehydration, consistent with the
hypernatremia finding. The nurse should prioritize fluid resuscitation and electrolyte replacement per
provider orders.
Q8. A client with chronic kidney disease stage 4 has a serum potassium of 6.2 mEq/L. Which medication
should the nurse anticipate administering?
A. Furosemide 80 mg IV push
B. Sodium polystyrene sulfonate (Kayexalate) 15 g PO
C. Calcium gluconate 1 g IV
D. Regular insulin 10 units IV with dextrose 50%
Correct Answer: C
Rationale: With a potassium of 6.2 mEq/L (severe hyperkalemia), calcium gluconate is the first-line
Nursing I Galen College ACTUAL
EXAM 2026/2027 | Galen NU 155 Med
Surg I Final | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: FLUID & ELECTROLYTES (Questions 1–15)
Q1. A client with heart failure has a serum potassium of 2.9 mEq/L and is prescribed furosemide 40 mg
IV. Which action should the nurse take first?
A. Administer furosemide as ordered
B. Check the client's last serum magnesium level
C. Hold the furosemide and notify the provider
D. Apply cardiac monitoring leads
Correct Answer: C
Rationale: Furosemide is a loop diuretic that exacerbates potassium loss. With a serum potassium of 2.9
mEq/L (severe hypokalemia), administering furosemide increases the risk of fatal dysrhythmias. The
nurse must hold the medication and notify the provider for potassium replacement before diuresis. This
follows the priority framework of treating life-threatening electrolyte imbalances before completing
other actions.
Q2. A client is admitted with diabetic ketoacidosis. Arterial blood gas results show: pH 7.28, PaCO₂ 28
mmHg, HCO₃⁻ 14 mEq/L, PaO₂ 92 mmHg. Which interpretation is correct?
A. Respiratory acidosis with partial compensation
B. Metabolic acidosis with full compensation
,C. Metabolic acidosis with partial compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: C
Rationale: The pH of 7.28 indicates acidemia. The low HCO₃⁻ (14 mEq/L) is the primary disorder,
indicating metabolic acidosis. The PaCO₂ is decreased to 28 mmHg, showing the lungs are attempting to
compensate by hyperventilating, but the pH remains abnormal, indicating only partial compensation.
Full compensation would return the pH to the normal range (7.35–7.45).
Q3. A postoperative client has the following lab values: Na⁺ 132 mEq/L, K⁺ 3.2 mEq/L, Cl⁻ 98 mEq/L, Ca²⁺
8.4 mg/dL. The client reports numbness around the mouth and muscle cramps. Which intervention is
the priority?
A. Administer 0.9% NaCl at 125 mL/hr
B. Administer oral potassium chloride 40 mEq
C. Administer IV calcium gluconate per protocol
D. Increase oral fluid intake to 3 L/day
Correct Answer: C
Rationale: The client exhibits signs of hypocalcemia (numbness around mouth, muscle cramps) with a
serum calcium of 8.4 mg/dL (normal 8.5–10.5 mg/dL). Hypocalcemia can lead to tetany, laryngospasm,
and seizures. IV calcium gluconate is the priority intervention to prevent life-threatening complications.
The ABC framework and safety priority guide the nurse to address the most immediately dangerous
electrolyte imbalance first.
Q4. A client receiving total parenteral nutrition (TPN) at 75 mL/hr develops chills, temperature 38.9°C
(102°F), and blood pressure 88/52 mmHg. Which action should the nurse take first?
A. Draw blood cultures from two separate sites
B. Discontinue the TPN infusion and change the tubing
C. Administer acetaminophen 650 mg PO
D. Increase the IV fluid rate to 150 mL/hr
Correct Answer: B
Rationale: The client exhibits classic signs of catheter-related bloodstream infection (CRBSI) or sepsis
from contaminated TPN. The first priority is to remove the source of infection by discontinuing the TPN
and changing the tubing. This follows the principle of eliminating the causative agent before supportive
interventions, aligning with infection control priorities and sepsis bundle protocols.
,Q5. [SELECT ALL THAT APPLY] A client with syndrome of inappropriate antidiuretic hormone (SIADH) has
the following findings. Which findings are consistent with this diagnosis? (Select all that apply.)
A. Serum sodium 118 mEq/L
B. Urine specific gravity 1.030
C. Serum osmolality 240 mOsm/kg
D. Blood pressure 168/96 mmHg
E. Urine output 3,500 mL in 24 hours
F. Decreased deep tendon reflexes
Correct Answers: A, B, C, F
Rationale: SIADH is characterized by water retention and dilutional hyponatremia. Serum sodium below
135 mEq/L (A) is the hallmark finding. Urine specific gravity is elevated (B) because ADH promotes water
reabsorption in the collecting ducts, concentrating the urine. Serum osmolality is low (C) due to dilution.
Decreased deep tendon reflexes (F) occur with severe hyponatremia as water shifts into cells causing
cerebral edema. Blood pressure is typically normal or slightly elevated, not severely hypertensive (D).
Urine output is decreased, not increased (E), because of water retention.
Q6. [ORDERED RESPONSE – PRIORITY] A nurse is caring for a client with hypovolemic shock secondary
to severe diarrhea. Place the following interventions in order of priority.
1. Insert a large-bore IV catheter and begin fluid resuscitation
2. Apply supplemental oxygen at 15 L/min via non-rebreather mask
3. Obtain a complete set of vital signs
4. Place the client in Trendelenburg position
Correct Answer: 2, 3, 4, 1
Rationale: The ABC priority framework guides this sequence. First, apply supplemental oxygen (2) to
address potential hypoxia and support tissue perfusion. Next, obtain vital signs (3) to establish a
baseline and guide intervention intensity. Then, place the client in Trendelenburg position (4) to
improve venous return to the heart and cerebral perfusion. Finally, insert a large-bore IV and begin fluid
resuscitation (1) to restore intravascular volume. Oxygenation takes precedence over circulation in the
initial stabilization phase.
Q7. [HOT SPOT – LAB VALUE INTERPRETATION] A client's laboratory report shows the following values.
Identify which values are ABNORMAL and require nursing intervention.
Table
, Lab Value Result Normal Range
Serum Na⁺ 148 mEq/L 135–145 mEq/L
Serum K⁺ 4.2 mEq/L 3.5–5.0 mEq/L
Serum Cl⁻ 102 mEq/L 98–106 mEq/L
Serum Mg²⁺ 1.4 mg/dL 1.7–2.2 mg/dL
Serum Phos 4.8 mg/dL 2.5–4.5 mg/dL
BUN 32 mg/dL 7–20 mg/dL
Creatinine 1.1 mg/dL 0.6–1.2 mg/dL
Correct Answer: Abnormal values requiring intervention: Na⁺ 148 mEq/L (hypernatremia), Mg²⁺ 1.4
mg/dL (hypomagnesemia), Phos 4.8 mg/dL (hyperphosphatemia), BUN 32 mg/dL (elevated).
Rationale: Hypernatremia (148 mEq/L) indicates dehydration or excess sodium intake and requires fluid
management. Hypomagnesemia (1.4 mg/dL) increases risk of dysrhythmias and often accompanies
hypokalemia and hypocalcemia; magnesium replacement is needed before other electrolytes will
correct. Hyperphosphatemia (4.8 mg/dL) suggests renal impairment or tissue breakdown. Elevated BUN
(32 mg/dL) with normal creatinine suggests prerenal azotemia from dehydration, consistent with the
hypernatremia finding. The nurse should prioritize fluid resuscitation and electrolyte replacement per
provider orders.
Q8. A client with chronic kidney disease stage 4 has a serum potassium of 6.2 mEq/L. Which medication
should the nurse anticipate administering?
A. Furosemide 80 mg IV push
B. Sodium polystyrene sulfonate (Kayexalate) 15 g PO
C. Calcium gluconate 1 g IV
D. Regular insulin 10 units IV with dextrose 50%
Correct Answer: C
Rationale: With a potassium of 6.2 mEq/L (severe hyperkalemia), calcium gluconate is the first-line
